Provider Demographics
NPI:1164510046
Name:BRAUN, ELLIOT JAY (DPM)
Entity Type:Individual
Prefix:DR
First Name:ELLIOT
Middle Name:JAY
Last Name:BRAUN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1371 MONTLIMAR DR
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36609-1645
Mailing Address - Country:US
Mailing Address - Phone:251-304-0804
Mailing Address - Fax:251-304-0806
Practice Address - Street 1:1371 MONTLIMAR DR
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36609-1645
Practice Address - Country:US
Practice Address - Phone:251-304-0804
Practice Address - Fax:251-304-0806
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00064213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL70437OtherBC/BS ALABAMA
AL000070437Medicare ID - Type Unspecified
ALT68867Medicare UPIN